If everything else has failed to provide improved comfortable vision, Scleral Contact Lenses may well be the answer in cases where the cornea has been compromised.
How it works
Scleral contact lenses are large-diameter gas permeable contact lenses specially designed to vault over the entire corneal surface and rest on the “white” of the eye (sclera). In doing so, scleral lenses functionally replace the irregular cornea with a perfectly smooth optical surface to correct vision problems caused by keratoconus and other corneal irregularities. The space between the cornea and the back surface of scleral lenses acts as a fluid reservoir to provide comfort for people with severe dry eyes who otherwise could not tolerate contact lens wear. The space between the cornea and the lens is filled with artificial tears. The liquid, which is contained in a thin elastic reservoir, conforms to the irregularities of the deformed cornea, allowing vision to be restored comfortably. This is often the only way to give these patients comfortable, functional vision.
Our optometrist Willem Pieterse has done a course at the London Refraction Hospital where he worked with Dr Ken Pullum, who is a globally renowned expert on sceral lens fitting. Willem has had some excellent results with problem cases where scleral lenses proved to be the only solution.
Indications for use
Scleral lenses may be used to improve vision and reduce pain and light sensitivity for people suffering from a growing number of disorders or injuries to the eye, such as:
- Corneal ectasia
- Stevens–Johnson syndrome
- Sjögren’s syndrome
- Neurotrophic keratitis (aneasthetic corneas)
- Complications post-LASIK
- Complications post-corneal transplant
- Pellucid degeneration
- Traumatic injury
- High myopia or astigmatism
Scleral Lenses can also be used for therapeutic purposes such as:
- Protecting the cornea from damage by the eyelids and eyelashes in conditions such as trichiasis.
- Providing hydration to the cornea in severe cases of dry eye including Stevens Johnson Syndrome, cicatricising pemphigoid and GVH disease.
- Keeping the cornea hydrated in conditions where the eyelids do not close properly such as facial nerve palsy or following trauma.
- Improving the appearance of a drooping eyelid (ptosis).
In these cases scleral lenses may also provide visual improvement directly – by correction of the focusing error and indirectly – by improvement in the condition of the corneal refracting surface. Scleral lenses can also be made as cosmetic lenses to be used in cases of chronic double vision (to block out the second image), aniridia (to provide a false iris), microphthalmus (to increase the size appearance of the eye) or as a full cosmetic shell to cover and alter the appearance of an eye.
The fitting process
Scleral contact lenses are custom-made for each wearer, so fitting scleral contacts demands greater expertise and more time than fitting standard soft or GP contact lenses.
Computerized maps of the contour of the entire cornea are generated to facilitate the lens fitting and several trial lenses of different sizes and curvatures may be applied to the eye during the fitting process.
Depending on the complexity of the problem and how the individual eye tolerates the scleral lens, adjustments of lens parameters may be needed, which will require additional lenses to be made and exchanged. The entire scleral lens fitting process can take several visits to determine the optimal lens for each eye.
Life changing testimonials
My name is Sunel and I am 54 years old. I am a secretary at the Department of Justice.
I started experiencing problems with regards to my eyes and vision in 1995, my biggest problem was reading. I tried spectacles, but I still couldn’t read…not near or far. I constantly had to ask colleagues for help with small prints and numbers. Working on the computer wasn’t as bad, because I could enlarge the font size, but with being a secretary comes a lot of paper work.
I soon realized that I found it more difficult to recognise people in the passage and was never sure who came into my office. I started guessing about many things.
I received my first corneal transplant in the right eye in 1997. Thereafter I had another 4 corneas in the left eye, unfortunately the problems got worse and I developed glaucoma as well. I then lost sight in my right eye and now have an ocular prosthesis in my right eye. I also had cataracts removed from both eyes. In total I had about 20 procedures done to try and correct my vision.
I felt lost in unfamiliar places because I could not see far enough to know exactly where I was heading to. My eyes were extremely light sensitive and when we would go on holiday, I could no longer enjoy the scenery. When out doing shopping I couldn’t even read the price tags. All colours appeared to be washed out, I couldn’t sow or watch TV as time had progressed.
Then in 2012, Willem Pieterse came to my rescue. My vision at the time was recorded with spectacles as 0.4(40% on the reading chart) He told me about the Scleral contact Lens and I decided to give it a chance because by then, I was desperate! He fitted me with the lens then My Whole Life Changed!! When I stepped outside there was no light sensitivity, I could see the blue sky, the road signs and even street names. That evening I watched a rugby match on TV and for the first time I could see the score and the time. I couldn’t take my eyes off the screen and I don’t even like rugby.
The fitting sessions were good and I felt no discomfort. It felt strange at first but not painful. Once you have the technique of inserting it and taking it out it is like breathing- very easy. I put my lens in at 08h00 and wear it for about 15hours a day.
I can now see expressions on people’s faces. No more guessing. The scleral lens changed my life and gave me a couple of years longer to continue working. I have my confidence back and the joy of seeing again is worth anything in this world.
My name is Renate van Straten, I am 50 years of age and a Home executive from Randburg.
My vision affected my daily life so badly that I had to give up shopping, my housework and my favourite pass-time, painting. Gardening, shopping and watching TV became a burden. Cleaning became impossible as I couldn’t see the dust, as a result thereof I had to get a domestic worker.
It was depressing; I couldn’t do my housework or keep myself busy with my hobbies. I even considered getting a guide dog, as I was practically blind.
Eighteen years ago I had a Corneal transplant, which was very successful. I had great vision, no discomfort and could go about my everyday life as normal again. That was until two years ago, when my vision deteriorated again and I was told I can not undergo any further operations.
The eye specialist then referred me to Willem Pieterse that has a special interest for advance contact lens fitting. My vision was recorded as 6/24(33% on the reading chart) and not even close to the required 6/9 required for legal driving criteria.
In the beginning I was anxious about the whole thing. I didn’t know what to expect. The idea of touching my eyes freaked me out, and I was scared that the lenses would damage my corneas even further, but Willem explained everything so nicely to me and reassured me that everything will be okey.
What a life changing experience! My vision improved to in my left eye to 95% and 75% vision with the Scleral Lenses. I can finally have a normal life again, do my own cleaning, gardening, shopping, watching TV and drive a car. I’m even starting to paint again.
I started wearing the lenses for 4 hours at a time and slowly worked my way to wearing them full-time. Once you get used to it, you hardly know you’re wearing them. Just bear with it, and you’ll get used to it. It’s definitely worth it.
My name is Louis, and I am a draughtsman by profession and just over 40 years old. In my line of work I spend an enormous amount of time in front of the computer. I also go out to site regularly.
When working outside my eyes were severely affected by the bright light of the sun and I had to wear sunglasses to block out most of the light as my eyes were very sensitive to it. I use to suffer from terrible headaches as a result of the strain of the PC and the light when working on sites.
A few years ago Dr. C Van Niekerk, an Eye Specialist assisted with a corneal transplant after my Keratoconus got out of hand.
I underwent several operations, two laser treatments and a cornea transplant. I then received an artificial lens that was implanted in the eye. The vision improved but any bright light was still a huge problem for me. When I visited the Optometrist Willem for the first time; My vision with the soft contact lenses was recorded as 0.4(40%) on the reading chart. This was actually not even in the criteria for driving.
There has been a drastic improvement since I got Scleral contact lenses, it blocks out most of the light and I am no longer suffering from severe headaches as I did before.
My vision improved for both eyes dramatically and at the same time the cosmetic appearance of the right eye looks exactly the same as my left eye, which means that I don’t feel as self-conscious about my right eye looking differently.
The comfort of the lens is extremely good, so good that, at times I forget I have it in. In the beginning it took some time getting use to and was not so easy to put it in or take it out, but once I got use to it, it took only seconds to put it in and take it out. I would, without a doubt recommend Scleral lenses to anyone who needs it.
My name is Joanne Edwards, I’m currently still in school, doing grade10. When I was in Grade 7 I discovered that my vision was not 100%. I had some visibility, I knew my vision was reduced but did not realise that it was a serious condition, so it did not bother me much because things were still visible. My vision got progressively worse once I started grade 8 and started deteriorating. I told my parents about my vision and then they took me to see Dr. Tony Dos Ramos, He is an Ophthalmologist. He conducted eye tests and diagnosed me with Keratoconus stage 3-4 in both eyes. We did not understand what that was at the time, so he explained to us that I probably got it by continuously rubbing my eyes when they were itchy. Instead of rubbing it lightly I may have rubbed with intense pressure, or another reason could be that it is a genetic condition. Dr. Tony said that the shape of a normal eye is in the shape of a sphere or a soccer ball shape, but mine has already formed into the shape of a rugby ball, which made my vision as unclear as it is now.
At first I went to an optometrist in the area, who then tested my eyes and prescribed ‘small hard contact lenses’. It worked perfectly! But it was not very comfortable and I was not able to wear it for the whole day. After complaining about the comfort of the lens, he then fitted an un-ordinary lens which was soft but larger than normal, the vision was not satisfactory, but was better than my own eyesight. The optometrist said he wanted to try the ‘piggy back’ option which was where I had to wear the soft lens and then the hard contact lens on top of that of which the end result was not successful. My father then took me to Dr. Stef Guglielmetti; He then tested my eyes and suggested I go for the Kera-ring operation, which would mean placing a permanent contact lens in my eye. He did mention that the operation was reversible. At first my vision was unclear, but the doctor did say that it would take about a month to heal. After a month, I noticed an improvement, for the first time I could see steam from the bathtub and steam from a cup of coffee!!!! It was a very emotional moment for me and my family was so happy for me. Alas, this didn’t last very long, my vision started deteriorating again, and I was very disappointed. Dr. Guglielmetti then advised us that there is only one option left for me, and this was the ‘laser’ operation done with a ‘cross-linking’ procedure; If this was not successful, then I would have to go for a ‘cornea transplant’, which was not an option for us as at this stage. We wanted to exhaust all other avenues prior to doing the cornea transplant. I then went for the ‘laser and cross-linking’ operation, but it was not as successful as we expected. Dr. Guglielmetti then referred me to Optometrist Willem Pieterse. Willem then tested my eyes and suggested that he will try a ‘Scleral lens’.
My vision at this moment with a ‘Scleral lens’ is phenomenal; I can see…..I can see….my feelings are indescribable. I am so happy with the as my vision is much better, in fact it went from 10% to 95% with this lens. I never knew my eyes were as bad as it seemed until I received these lenses. I could never see the acne on my face, neither the nails on my toes until now. Without these lenses I have 10% vision which isn’t much. At night I cannot even see where I am going, I have to hold onto someone to make sure where I am going but now that I have these lenses I am grateful That Willem discovered and developed them for South Africa. Without these lenses I would not be able to see the beauty of life.
My name is Fikile Hlubi, I am currently working for Wesbank as an HR Officer. My vision or the lack thereof affected me tremendously; I couldn’t apply for HR jobs that required a lot of travelling due to the fact that I couldn’t drive.
In 1994 I had a corneal transplant on both eyes and my vision had improved. I’ve been wearing spectacles ever since, but my eyes was deteriorating gradually over the years and the spectacles just wasn’t helpful anymore.
My vision was recorded with spectacle correction as 0.25 (25%) on the reading chart with both eyes. The left eye is due for another corneal transplant soon.
The eye specialist first referred me for the possibility of specialised contract lens fitting on the right eye. My vision has improved a lot since Willem fitted me with Scleral Lenses on the right eye. I am now able to see my laptop clearly, I’m learning to drive and I can see people from a distance. Initially I battled to put the lenses on, but only for a few days, now it’s quite easy to put the lenses in. The Scleral lens is without a doubt worthwhile, it sits comfortably on the eye and you even forget you are wearing it.
For people like me, who has Keratoconus, wearing scleral lenses is not an option but more a necessity.
I would suggest that the optometrist educate the medical aids about this condition and help them realize that we wear the scleral lens not for cosmetic reasons but for a much more improved eyesight
In addition I would like to express my sincerest gratitude both to Willem and his colleagues, for their patience and hard work….Wearing the scleral lens has been life changing. I’m now able to pursue things which I thought I could never do, well at least not in this lifetime J…Your work is life changing and is does not go unnoticed!
My name is Heather Dube, a matriculant at Pricess High School.
I started wearing spectacles permanently at the age of six years, because I had problems with my vision for as long as I can remember. My eyes were often red, itchy and swollen due to seasonal allergies, aside from this, my vision has always been bad. It affected my school work negatively as I would be absent from school for regular doctor’s consultations.
I had huge problems with computer lessons and I couldn’t even read for a long time. I did not undergo any operations but I had to use prescribed eye drops, which just relieved the red, itchy eyes that came with the allergies, but nothing could improve my vision.
My optometrist advised my parents to seek a second opinion and that is how I ended up in Willem’s consultation chair.Before the Scleral lenses we tried a different set of hard lenses which my eyes rejected, and Willem then introduced me to Sclerals. My vision has improved drastically, there is a huge difference now that Im wearing scleral lenses. He is avoiding Corneal surgery for as long as possible.
I am very comfortable with the lenses to an extent that I usually forget that I have them on. The lenses have a positive impact on my life.